Impact of media coverage on side effect reports from the COVID-19 vaccine.

OBJECTIVE: Past research shows that media coverage of medicine side effects can produce a nocebo response. New Zealand news media discussed myocarditis following the Pfizer COVID-19 vaccine. This study examined whether side effects mentioned in the media increased compared to control symptoms not mentioned. METHODS: The study analysed 64,086 vaccine adverse reaction reports, retrieved from the medicine safety authority. Generalised linear regressions compared the side effect rate during three discrete periods of media reporting (August 2021, December 2021, April 2022) with the pre-media baseline rate. The outcomes were weekly reports of chest discomfort, monthly reports of chest, heart and breathing symptoms, and myocarditis, pericarditis, and anxiety. Control symptoms were fever, numbness, and musculoskeletal pain. Logistic regressions investigated factors associated with side effect reporting. RESULTS: The reporting rate of chest discomfort was 190% greater in the five weeks after the first media item (p < .001). The monthly reporting rates of the symptoms mentioned in the media were significantly greater after the news coverage (ps ≤ 0.001). There was no effect of media on the control side effect fever (p = .06). There was an effect of media on myocarditis, pericarditis and anxiety (ps < 0.001). Anxiety, male gender, and younger age were significantly associated with side effects. CONCLUSION: The results indicate that a media-induced nocebo response occurred. This is most likely due to increased expectations and awareness of COVID-19 vaccine side effects, elevated symptom experience from anxiety, and consequently greater reporting of the symptoms in line with the media coverage.

Health Scares: Tracing Their Nature, Growth and Spread.

Background: Health scares are highly publicised threats to health that increase public concern and protective behaviours but are later shown to be unfounded. Although health scares have become more common in recent times, they have received very little research attention. This is despite the fact that health scares often have negative outcomes for individuals and community by affecting health behaviours and causing high levels of often unnecessary anxiety. Method: In this paper we undertook a review and analysis of the major types of health scares as well as the background factors associated with health scares and their spread. Results: We found most health scares fell into seven main categories; environmental contaminants, food, malicious incidents, medical treatments, public health interventions, radiation from technology and exotic diseases. For most health scares there are important background factors and incident characteristics that affect how they develop. Background factors include conspiracy theories, trust in governmental agencies, anxiety, modern health worries and wariness of chemicals. Incident characteristic include being newly developed, not understood or unseen, man-made rather than natural and whether the incident is out of personal control. We also identified the aspects of traditional and social media that exacerbate the rapid spread of health scares. Conclusion: More research is needed to identify the characteristics of media stories that intensify the levels of public concern. Guidelines around the media's reporting of health incidents and potential health threats may be necessary in order to reduce levels of public anxiety and the negative public health impact of health scares.

Increasing and dampening the nocebo response following medicine-taking: A randomised controlled trial.

OBJECTIVE: The nocebo effect is the adverse effects of treatment that cannot be attributed to a medicine. We investigated if we could increase or decrease nocebo responding following medicine taking. A nocebo explanation to reduce side effects was compared with a negative medication news item designed to increase side effects and a control condition. METHODS: 108 healthy participants enrolled in a between-subjects study purportedly testing the effect of lamotrigine (actually placebo) on mood and cognition. Participants were randomised to watch either a video explaining the nocebo effect; a negative media item on lamotrigine, or control video prior to receiving the tablet. Side effects were assessed at 45-min and 48-h. RESULTS: The negative media group reported significantly more side effects (M = 0.78, SD = 1.53) than the control group (M = 0.46, SD = 1.80, p = .035) at the end of session and a greater proportion of the negative media group (33%) reported at least one side effect compared to the nocebo explanation (11%) and control group (11%, p = .020). The nocebo explanation group reported significantly fewer side effects (M = 0.38, SD = 1.16) than the control group (M = 1.37, SD = 2.98, p = .038) at the 48-h follow-up. CONCLUSION: Explaining the nocebo effect may be a beneficial addition to standard medicine information for reducing side effect reporting. Negative media coverage about a drug is likely to generate increased side effects. Future research should examine the benefit of nocebo explanation in patients starting new medicines.

When symptoms become side effects: Development of the side effect attribution scale (SEAS).

OBJECTIVES: Symptom misattribution is a central process in the nocebo effect but it is not accurately assessed in current side effect measures. We have developed a new measure, the Side Effect Attribution Scale (SEAS), which examines the degree to which people believe their symptoms are treatment side effects. METHODS: The SEAS was tested in three New Zealand studies: a vaccination sample (n = 225), patients with gout or rheumatoid arthritis (n = 102), and patients switching to a generic medicine (n = 69). The internal reliability of the scale was examined using Cronbach's alpha. To assess validity, the Side Effect Attribution Total Score and Side Effect Attribution Binary Score were related to a number of psychological measures associated with side effect reporting. RESULTS: The scale showed good internal reliability across the three studies, with Cronbach alphas ranging from 0.840 to 0.943. Analysis of the effect sizes showed that the Attribution Total Score was generally more strongly associated with nocebo responding than Attribution Binary Score. Participants had greater Side Effect Attribution Total Scores if they had higher expectations for vaccination side effects (r = 0.18, p = .028), more worry about future vaccine effects (r = 0.16, p = .046), a higher perceived sensitivity to medicines (r = 0.50, p < .001), greater anxiety (r = 0.25, p = .016), greater intentional non-adherence (r = 0.30, p = .003), greater medicine information seeking (r = 0.26, p = .010), lower trust in pharmaceutical agencies (r = -0.29, p = .026), and lower medicine efficacy beliefs (r = -0.46, p < .001). CONCLUSIONS: The SEAS provides a more nuanced assessment of symptom attribution beliefs. It appears to be more sensitive measure than just a side effect total, as it is associated with a greater number of relevant psychological variables. Future research should examine the scale in other populations and settings.

The effect of symptom-tracking apps on symptom reporting.

OBJECTIVE: The use of health apps is increasing worldwide, with a common feature being daily symptom tracking. However, symptom tracking has been shown to increase symptom reporting. This study investigated whether using a menstrual-monitoring app with a symptom-tracking feature increases symptom reporting compared to an app without this feature or no app at all. DESIGN: Experimental study. METHODS: Ninety-one participants were randomly allocated to use either a menstrual-monitoring app with a symptom tracker or a simple calendar app, or to a no app control group. The number of period-related symptoms as well as general symptom reporting was assessed at baseline prior to group allocation and then 1 and 4 months later. The change in the proportion of people classified as high symptom reporters was also examined. RESULTS: We found that the symptom-tracking app group reported significantly more period-related symptoms at 4 months than the calendar app group (mean difference = 1.16 symptoms, p = .010). At the 4-month time point, significantly more participants in the symptom-tracking group were now classified as high period symptom reporters (baseline 50%, 4 months 70%, p = .031), while the other two groups did not change from baseline. There were no differences in general symptom reporting across the three groups. CONCLUSION: A period-monitoring app with a symptom tracker may increase the reporting of period symptoms. This effect does not appear to generalize to broader symptom reporting. Further research is needed to support these findings and to examine the impact of symptom-tracking apps on daily functioning and health anxiety. Statement of contribution What is already known on this subject? The experience of transient symptoms is common in day-to-day life. These symptoms often do not have an underlying cause or are a sign of illness. Actively tracking symptoms has been shown to result in greater symptom reporting, symptom severity, and slower recovery from injury. The use of health apps is increasing, with a common feature being symptom tracking. Menstrual-monitoring apps, in particular, frequently require users to track symptoms. What does this study add? Using a menstrual-monitoring app with a symptom tracker for 4 months increases the number of period-specific symptoms reported compared a basic calendar app. A greater proportion of people were now classified as high period symptom reporters after using the symptom-tracking app. These effects do not seem to generalize to broader non-specific symptom reporting.

The impact of the illness label 'gout' on illness and treatment perceptions in Maori (Indigenous New Zealanders).

BACKGROUND: Despite contemporary advances in understanding pathogenesis and effective management of gout, beliefs about the disease continue to be focused on gout as a self-inflicted illness. The illness label itself may contribute to inaccurate perceptions of the disease and its management. In Aotearoa/New Zealand, Maori (Indigenous New Zealanders) have high prevalence of severe gout. The aim of this study was to examine the impact of the illness label 'gout' on perceptions of the disease and its management for Maori. METHODS: Maori supermarket shoppers (n = 172) in rural and urban locations were recruited into a study examining the perceptions about arthritis. Participants were randomised 1:1 to complete a questionnaire examining the perceptions of the same illness description labelled as either 'gout' or 'urate crystal arthritis'. Differences between the two illness labels were tested using independent sample t-tests. RESULTS: 'Gout' was most likely to be viewed as caused by diet, whereas 'urate crystal arthritis' was most likely to be viewed as caused by aging. 'Urate crystal arthritis' was seen as having a wider range of factors responsible for the illness, including stress or worry, hereditary factors and chance. 'Gout' was less likely to be viewed as having a chronic timeline, and was perceived as being better understood. Dietary management strategies were seen as more helpful for management of the gout-labelled illness. CONCLUSIONS: This study has demonstrated that for Maori, Indigenous New Zealanders who are disproportionately affected by gout, the illness label influences perceptions about gout and beliefs about management.

The Effect of Television and Print News Stories on the Nocebo Responding Following a Generic Medication Switch.

Background: Following a nationwide switch to a generic antidepressant, a series of negative media stories publicised the experiences of some patients having side effects following the switch. This occurred first in print media and five months later it occurred again in television news. In this study we examined the effect of television news stories compared to print stories on adverse drug reaction reporting. We also examined the change in reporting rate of specific side effects mentioned in the TV news bulletins. Method: Using an interrupted time series analysis of data from a national adverse reactions database, we compared the number of adverse reaction reports after the print and television coverage and the changes in reporting rate of side effects mentioned and not mentioned in TV news stories. Results: We found a significant increase in adverse reaction reports following TV news items that discussed patients' reports of side effects following the medication switch (interruption effect = 73.25, p = .046). The reporting rate of symptoms mentioned in the TV news bulletins also increased, in particular suicidal thoughts (interruption effect = 23.60, p = .031). The effect of TV stories on adverse reaction reports was 211% greater than the print articles. Conclusions: Television stories have a much stronger effect than print media on nocebo responding and specific symptoms mentioned in the bulletins have a direct influence on the type of side effects subsequently reported. Media guidelines should be developed to reduce the negative public health effects of media coverage following medication switches.

The effect of rebranding generic medicines on drug efficacy and side effects.

Objective: Branded medicines have a greater placebo effect, resulting in a heightened therapeutic response, whereas generics are associated with greater side effect reporting. These two studies investigated whether enhancing the appearance of a generic medicine could increase placebo and decrease nocebo responding.Design: Two experimental studies allegedly examining the effect of ß-blockers (actually placebos) for pre-examination anxiety. In Study 1, participants received either a generic ß-blocker with enhanced packaging, a plainly packaged generic or a branded ß-blocker. Study 2 compared an enhanced packaging generic to a plainly packaged generic ß-blocker.Main outcomes measures: Blood pressure, heart rate, anxiety and the number of symptoms and side effects reported.Results: Study 1 found no differences between the three groups for blood pressure, heart rate, or anxiety. Study 2 showed similar results but a significant difference in anxiety was found with the plain generic group experiencing a greater reduction in anxiety than the enhanced generic group. No differences in symptoms or side effects were found in either study.Conclusions: While the sample characteristics and familiarity of the medicines may have influenced the findings, we found no evidence that enhancing the branding of generic medicines improved response to the medication or reduced side effects.

What is associated with increased side effects and lower perceived efficacy following switching to a generic medicine? A New Zealand cross-sectional patient survey.

OBJECTIVE: Following a switch from either a generic or branded antidepressant (venlafaxine) to a new generic, we investigated the factors associated with a preference for branded medicines, side effects reported following switching and efficacy ratings of the new generic drug. DESIGN: A cross-sectional survey of patients switched to a new generic. SETTING: Patients accessing venlafaxine information online from the New Zealand government pharmaceuticals funding website. PARTICIPANTS: 310 patients, comprising 205 originally on branded venlafaxine and 105 previously taking a generic version. MAIN OUTCOME MEASURES: An online questionnaire assessing demographic factors, perceived sensitivity to medicines, trust in pharmaceutical agencies, sources of switch information, preference for branded medicine, new medicine perceptions, side effects and efficacy ratings. RESULTS: Preference for branded medicine was significantly stronger in older patients (OR=1.04, 95% CI 1.01 to 1.05), those taking branded venlafaxine (OR=2.02, 95% CI 1.13 to 3.64) and patients with a higher perceived sensitivity to medicine (OR=1.23, 95% CI 1.06 to 1.19). Different factors predicted side effects in those switching from the branded and those switching from the generic venlafaxine. Trust in pharmaceutical agencies and the number of side effects were significant predictors of efficacy ratings of the new generic in both patients switching from a branded and those switching from a generic version of venlafaxine. CONCLUSIONS: In patients switching from a branded medicine and those already taking a generic, different demographic and psychological factors are associated with preference for branded medicine, side effect reporting and perceived efficacy of the new drug. When switching to new generic, there appears to be a close bidirectional relationship between the experience of side effects and perceived drug efficacy. Trust in pharmaceutical agencies impacts directly on perceived efficacy and increasing such trust could reduce the nocebo response following a generic switch.

An illness by any other name: The effect of renaming gout on illness and treatment perceptions.

OBJECTIVE: Inaccurate lay views of an illness can lead to the adoption of unhelpful coping strategies and treatments. Gout is an example of an illness where the popular view of the condition conflicts with a modern understanding of the illness by overemphasizing the role of diet and alcohol in the development and management of the disease. In this study we investigated the effect of renaming gout as urate crystal arthritis on the perceptions of the illness. METHOD: One-hundred and 89 supermarket shoppers participated in a study examining the perceptions of different types of arthritis. Participants completed a questionnaire that either used the term "urate crystal arthritis" (UCA) or "gout" for the label and a description of the disease. Participants rated likely causal factors, illness perceptions and the usefulness of various management strategies. RESULTS: Gout was perceived as being more likely caused by the patient's own behavior through poor diet and overconsumption of alcohol, while UCA was attributed to aging. The UCA-labeled illness was also viewed as a more chronic and serious condition, while the gout-labeled illness was seen as being more socially embarrassing and more under the patient's personal control. Management for the gout-labeled illness centered on dietary interventions, while the UCA-labeled illness was perceived as requiring long-term medication. CONCLUSION: Changing an illness label can have a significant effect on causal beliefs, illness perceptions, and management strategies. Changing illness labels may be useful where the lay perceptions of an illness are not aligned with a current understanding of the condition. (PsycINFO Database Record